What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

People with type 2 diabetes are using primary care services more frequently, but increased volume of clinical care does not correlate with better outcomes (1).

NICE quality standards recommend provision of lifestyle services for T2D patients which is an extra resource requirement for each practice, both in delivering these services and in providing aspects such as blood tests to monitor progress.

While the Public Health Collaboration (PHC) already delivers award winning services to PCNs through The Lifestyle Club , the patients we support experience delays in accessing their normal primary care services required for aspects including:

• GP/Nurse appointments for regular bloods to track progress in Hba1c levels; or
• GP appointments to adjust drug doses in line with improvements

This limits the patients visibility of their progress and impacts their drive & motivation to maintain momentum in their efforts to improve their health.

TLC-A-new-model-of-healthcare-18.10.2022 (PDF)

What does your project aim to achieve?

The Lifestyle Club (TLC) is an award-winning online health coaching service, helping people living with type 2 diabetes and prediabetes improve their lifestyles in a supportive environment with the aim of remission.

The project aims to reproduce the results of Dr Unwin on scale by enhancing the service level of TLC with digital integration, seamless patient pathways and a physical presence in the PCN. This would build in the required tests as patients reach individual milestones, deprescribing guidelines and appointments at the optimal points to improve outcomes & reduce costs, promotion of the achievements of the patient, the practice, the NHS & the TLC.

Provision of an integrated pathway would encourage wider uptake by PCNs, giving confidence that the patients they refer would be on the journey to better health.

How will the project be delivered?

A working group from our board of Trustees, Scientific Advisory Committee & partner PCNs will map out the full pathway of care for the target patient group, identifying each of the areas where delay or insufficient resource can be appropriately tackled by using the TLC service, specifically to reduce demand on GP & Nurse resource within this population.
The working group will design innovative contractual methods of fully integrating the service with a PCN in order to position patient activation at the heart of the service.

Currently, TLC is most commonly funded by the Alternative Role Reimbursement Scheme (ARRS) which is a cost effective approach to delivery of lifestyle coaching services shared across a full PCN. We will identify new, sustainable funding methods with our PCN partners, such as lifestyle prescribing to expand to providing a physical presence where required.

How is your project going to share learning?

This project will generate learning for Q members in both the improvement of patient pathways and in improving the target health goals for diabetic patients.

Creation of an integrated service led by a charity partner, focussed on patient outcomes will be transferable to many community treatment pathways.

Targeting remission of what was previously thought to be a chronic, degenerative condition will provide inspiration for others to reach the same achievement.

PHC would aim to host joint events with our partner PCNs to share learnings & outcomes with Q and beyond.

We would use our social media reach and grassroots network to share learnings and progress.

Our annual PHC conference, attended by hundreds of HCPs is also an ideal vehicle to share learnings of this project and the wider impact of PHC/NHS work on metabolic health.